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When to use Ice or Heat for a sports injury

This must be one of the most common questions that I’ve been asked in my years of practising as a physiotherapist. Whether you use ice or heat for your injury will depend on what phase of healing your injury is in.



In this article:

  • Immediately after injuring yourself

  • During the first 3 to 5 days of injury

  • After day 5

I explain this in a lot more detail in this video:



Immediately after injuring yourself


Phase of healing: Inflammatory phase


What to use: Ice


Why: Your main aim immediately after injuring yourself is to stop any internal bleeding and prevent excessive swelling. Excessive bleeding and swelling inside the tissue causes an increase in pressure which can cut the blood circulation off to the adjacent, uninjured cells. Without an adequate blood and oxygen supply these cells may also be damaged, causing your injury to be worse than what it should be.


Important: Do not apply the ice for more than 10 minutes at a time. I explain this in detail in the video but in short, if you apply it for more than 10 minutes the blood vessels may open up because the brain thinks that you are at risk of getting frost bite. This can then actually cause more bleeding. Check out this Ice User Manual for exact instruction on how to safely apply ice to an injury.


During the first 3 to 5 days of injury


Phase of healing: Inflammatory phase


What to use: Ice


Why: Some injuries can continue to ooze inside and we still don’t want the blood vessels to expand like they would if you put heat on the injury. During this phase ice is mainly used to control pain and swelling.


Ice can also calm down the inflammatory process and prevent excessive inflammation. Inflammation is an extremely important part of the healing process as it is needed to absorb the debris from the injury site. Excessive inflammation can however cause trouble. Please don’t take this to mean that you should be taking anti-inflammatory drugs like ibuprofen. These drugs may suppress the inflammatory response too much and actually interfere with your healing. You can read more about this and how to apply ice during this period in the Ice user Manual.


Important: Never apply ice directly to your skin as it can cause ice burns and blisters. Always place a wet cloth or towel between your skin and your ice pack.



After day 5


Phase of healing: Regeneration and remodelling phases


What to use: Ice or Heat or Contrast Therapy


Why: For most injuries the blood vessels will usually be fully repaired after day 5 (of course this may vary depending on your injury so check with your doctor or physio) so you no longer have to worry about internal bleeding. The main reason for using these modalities are:

  • Pain relief: Both ice or heat can work well for this. I usually let the patient decide what works best.

  • Reducing swelling: Ice and/or contrast therapy (where you alternate hot and cold) are usually used for this.

  • Improving circulation: Contrast therapy or heat may be best for this. The idea is that the increase in circulation helps to deliver more nutrients and oxygen to your injured tissue, helping it to heal more quickly. I’m not aware of any research to support or contradict this and some of my patients swear by it.

Important: You can injure yourself by applying heat or ice for too long. Never apply it to areas where your sensation is dull or numb. Using ice shortly before doing exercise can also predispose you to injuries because it numbs your nerve endings – check out the Ice User Manual for more detail on this. Never apply heat or contrast therapy over an area with signs of inflammation (red, hot, swollen) as it can make the inflammation worse.


Let me know if you have any questions. Need more help with an injury? You can consult me online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.

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